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From paper to paperless: Do electronic systems ensure safe and effective communication and documentation of DNACPR
Laura Harrington1, Kathryn Price2, Polly Edmonds3
1University College London Hospitals NHS Foundation Trust, London, UK laura.harrington6@nhs.net.
Introduction:
An electronic resuscitation system, implemented in 2015, within electronic patient records (EPR) at King's College Hospital NHS Foundation Trust was studied, aiming to review and improve decision documentation and communication.
Method:
The study (January 2018 - June 2018) included all gerontology inpatients with electronic do not attempt cardiopulmonary resuscitation (e-DNACPR) decisions. Cases were identified weekly, followed by retrospective analysis of discharges. Amendments to the electronic system and improvements were implemented between cycles. CYCLE 1: One-hundred and thirty-three patients were included; 85% had an e-DNACPR form; 86% of all forms had senior doctor involvement; 68% evidenced patient/relative discussion; 13% documented multidisciplinary team (MDT) discussion.
Interventions:
A mandatory 'named nurse' field was added to the form and trust-wide education programme implemented. CYCLE 2: One-hundred and twenty-six patients were included; 100% had an e-DNACPR form; 93% evidenced senior doctor involvement; 71% evidenced patient/relative discussion; 57% documented MDT discussion.
Conclusion:
Changes to the process and trust-wide education resulted in more robust documentation and communication.
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Critical attributes of NCIS include:
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Factual:
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